Could Legalizing All Drugs Solve America’s Opioid Epidemic?

19 Sep 2017

Jeffrey Miron

Drug policy in the U.S. is at a crossroads. On one hand, at
least 22 states have decriminalized recreational marijuana, eight
of which have gone a step further by legalizing it altogether. At
least 29 states permit medical marijuana for qualifying patients.
Several additional states look poised to consider legalization,
decriminalization, or medicalization in 2018. At the federal level,
Sen. Cory Booker (D-NJ) has
introduced a bill to end the national prohibition of marijuana.
U.S. policy toward marijuana, at least, is on a path toward
liberalization — if not outright legalization.

On the other hand, the opioid epidemic creates pressure in the
other direction. Many proposals for taming the epidemic involve
further constraining access (for example, Centers
for Disease Control and Prevention guidelines restricting
prescriptions or state laws limiting access to painkillers). In
addition, U.S. Attorney General Jeff Sessions seems intent on
reversing marijuana liberalizations, calling marijuana “only
slightly less awful” than heroin.

Given this tension over drug policy, it is useful to note some
of the positive outcomes of drug liberalizations around the
world.

Portugal is a prime example: It
decriminalized all drugs in 2001 amid a heroin addiction crisis
and soaring numbers of drug-related AIDS deaths. Possessing small
amounts of illicit substances is now treated as a public health
problem. Instead of facing jail time, drug users who are caught
must meet with medical experts, social workers, and psychologists
who assess their situation and often direct them toward treatment
or other rehabilitative services.

Around the world, liberal
drug policies have had great success in reducing the harms from
drug addiction, such as HIV and overdoses. Faced with a raging
opioid crisis, the U.S. would be wise to model its own drug policy
after countries that have undergone similar experiences.

The results of this policy have been astonishing. Drug use has
declined across
all age groups. Overdose deaths have plummeted to just
three per million adults, the second lowest rate in the
European Union. For comparison, the drug overdose death rate in the
U.S. is a staggering 185 per
million adults. Portugal’s drug-related
HIV infections have fallen by 94% since 2001. And the number of
people arrested for criminal drug offenses has declined by over
60%, which has allowed Portugal to channel money once spent on
arresting and imprisoning addicts toward more effective treatment
programs.

As described by one
Portuguese counselor who works directly with recovering
addicts, “It’s cheaper to treat people than to incarcerate them. …
If I come across someone who wants my help, I’m in a much better
position to provide it than a judge would ever be.” Unsurprisingly,
this humane approach to drug treatment has garnered
widespread support among Portuguese citizens.

Similarly, the Czech Republic has removed penalties for limited
personal use of marijuana, cocaine, heroin, LSD, and other
substances. The nation’s lenient polices encourage users to seek
treatment; largely as a result, annual overdose deaths are on par
with Portugal at about five per
million adults — much lower than the EU average.

Perhaps most radically, Uruguay fully legalized marijuana in
2013 and has decriminalized cocaine and heroin. While it is too
early to determine its long-term effects, the new policy has helped
Uruguay focus law enforcement resources on drug smuggling. The
country’s government even operates a program that sells cannabis
for just $1 per gram, making it difficult for black markets to
thrive.

Domestically, recent marijuana legalizations in Colorado,
Washington state, Oregon, and Alaska have yielded positive
outcomes. Numerous
studies show
little to no rise in marijuana use following legalization,
coupled with possible declines in cocaine and heroin use. Moreover,
legalizations appear to have had no impact on violent
crime and traffic
accidents, consistent with medical
research showing little association between marijuana and
impaired cognition or driving ability.

Critics of drug liberalization often warn that further
decriminalizing drugs in America will worsen the opioid epidemic.
Citing “gateway” effects, many commentators (such
as Sessions) advocate reducing opioid addiction via greater law
enforcement and heavier penalties against all substance possession
and use. But this reasoning ignores that opioids are already highly
restricted, and that previous attempts to control them more tightly
have been counterproductive.

Around the world, liberal drug policies have had great success
in reducing the harms from drug addiction, such as HIV and
overdoses. Faced with a raging opioid crisis, the U.S. would be
wise to model its own drug policy after countries that have
undergone similar experiences.

Jeffrey Miron is the director of economic studies at the Cato Institute and the director of undergraduate studies in the Department of Economics at Harvard University.

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